TMTalks: Justin Elliott: The Medicare Cap: Therapy Can’t Wait, Congress Can’t Either.

“Therapy can’t wait. Congress can’t either,” is APTA’s message to Congress regarding the Medicare Therapy Cap. The APTA, according to Justin Elliott, APTA VP for Government Affairs is in Full Court Press for therapy cap repeal by February 8th. He spoke honestly with us on January 26th about the challenges of moving legislation in our current political landscape, and was optimistic about the path forward to therapy cap repeal. 

The Policy isn’t the holdup

In October, leadership from both parties agreed to legislative language to fix the therapy cap. Congress rarely agrees about anything anymore, but they agreed on a policy to repeal the Medicare Therapy Cap. The hold up isn’t the policy.

The holdup is 3 P’s; Politics, Partisanship, and Process

Unfortunately the political landscape we are in is more perilous and challenging than ever. APTA began to worry in early December when CHIP, a bipartisan program that program that provides health insurance to children, wasn’t reauthorized. CHIP has since been authorized for 6 years as part of the deal that ended the government shutdown, but the DACA (Deferred Action for Childhood Arrivals) program  (which arguably led to the shut down) remains to be addressed. DACA and other larger immigration issues will be the political focus for the next several weeks as hundreds of thousands face deportation if an agreement is not reached. The hope, and expectation is that Congress should be able to pass a Medicare therapy cap fix, along with a number of other “Medicare extender” issues after a DACA deal is reached.

The APTA isn’t alone

APTA is part of a large coalition fighting for therapy cap repeal. In addition to provider groups like the APTA, American Occupational Therapy Association, and American Speech-Language, Hearing Association,, numerous patient advocacy groups like the Michael J Fox Foundation are calling for the cap’s repeal. The AARP recently launched their own campaign. The APTA is coordinating with all these groups to most effectively advocate for cap repeal.

Everyday hurts

Everyday more and more patients are hitting the cap. The Cap is also having a big impact on small clinics in terms of lost revenue. APTA encourages clinics to continue to submit claims with the KX modifier, as CMS is holding these claims temporarily to allow for legislative action.

The APTA is in Full Court Press

Justin Elliott reports the APTA in a full court press for cap repeal by Feb. 8th–the deadline for a budget deal before the government shuts down again. Recently APTA took out a number of full page ads in major newspapers, which are read by Legislators. APTA’s Congressional Affairs team of 4 full time staff and 2 contract lobbyists continue daily meetings with Congressional leadership and our congressional allies. In addition to continued calls for members to contact their legislators, the APTA is launching a new campaign to help put a human face to the harmful impact of the cap.  The APTA is asking for short patient videos (with their consent) describing how the cap has impacted them.


For a more in depth discussion of the history of the Medicare Therapy Cap, check out our July 31st interview with Justin Eliott, as well as our editorial from Jan 22th, 2018: Medicare Therapy Cap: Pipe Dream or Professional Responsibility

Stay tuned to Talus Media for more updates on the Medicare Therapy Cap, and be sure to use the hashtag, #StoptheCap, whenever tweeting, posting, or pinning or about the Cap.